Dealing with severe depression after disability
June 28, 2007 7:44 PM   Subscribe

Does anyone here have experience with severe depression following a permanent (partially but significantly) disabling injury at a young age (late teens, early 20's)?

I am looking for advice on what might help a person move beyond crippling depression when the circumstances in their life continue to be very difficult, as if life conspires repeatedly to beat them down into the ground, but doesn't have enough mercy to put an end to it. This is 4 years post-injury. Antidepressants barely help, and counseling makes the emotional pain even worse. Virtually all former friends abandoned immediately, and the two who didn't are nevertheless busy with their lives - dating, marriage, children.

Please don't reply unless you actually have had experience with something like this, yourself or as the parent of a "child" in that situation.
posted by onemorething to Human Relations (20 answers total) 3 users marked this as a favorite
 
your situation is pretty specific, but as the sibling of someone with a lifelong mental illness, i can offer this: you might need another counselor, and/or different drugs. you may also benefit from an inpatient program. don't give up.

it can be incredibly difficult to know how to be around someone who has suffered a disabling injury or who has a mental illness, and many people, especially if they are immature (as i presume your peers were when you were hurt) they may cope by withdrawing because they are overwhelmed by a sense of responsibility. sometimes they can't deal, and they leave. i don't say this to excuse them, but to explain.

i hope you continue to fight for your mental health. if you find your current therapy program too difficult to endure, you might benefit from a different strategy, like cognitive/behavioral therapy. instead of coming to terms with the traumatic event, it will help you to learn how to deal with the aftereffects, as well as breaking the cycles of negative thoughts that surround it. it is kind of like psychological physical therapy. if there is a hospital in your area, call the psychiatry department and ask if there is anyone on staff who specializes in cognitive therapy.

good luck. hang in there.
posted by thinkingwoman at 8:46 PM on June 28, 2007


btw, i am not a psychiatrist, so please consult with your therapist before making major changes.
posted by thinkingwoman at 8:48 PM on June 28, 2007


I shouldn't reply, but I'm going to anyway.

You don't want to hear from anyone who doesn't have experience with your specific class of problem. Have you considered that, perhaps, that is part of your problem? You cannot take the advice of others, because they could not possibly understand?

Pain and isolation is a surprisingly general, even human experience, onemorething. What you're feeling is quite normal -- and it's not the sort of thing that goes away on its own. Those who say blithely that "it'll get better, just you wait" are falling into the same trap you are. They're assuming your situation must be so much different.

It's not. Maybe it should be. But it isn't.

I offer this advice: Be useful. Be relevant. Be active. Make yourself important in the lives of others, nurse something into existence, *matter*. There is a peculiar pain to irrelevancy, and I'm not convinced you haven't consigned yourself towards that. Your mind is built to call upon the strength of your relevance, to battle the constant barrage of hardship. The game really is to construct in your mind the requisite framework of where you fit in.

What happened then is not part of that framework now.

Good luck.
posted by effugas at 9:41 PM on June 28, 2007


I apologize for responding at length although I do not have the specific experience you request, but I fear the situation is so specific it will garner little response. I do have extensive personal and family experience in dealing with depression, including severe depression.

What can be done about depression is effective medication, effective counseling and improving external conditions that contribute objectively to depression. I realize that I'm responding to very minimal information about the treatment strategies the depressed individual (unclear of this person's relationship to you) has pursued, but it seems like the first two approaches have been all but discounted, which I think is a mistake.

The issue of medication is constantly changing, both in the increased body of data on existing medications and in the development of new medications. I think the most rational context in which to explore a response to poorly effective medical treatment of depression is in an ongoing therapeutic relationship with a psychiatrist.

If counseling is worsening emotional pain, either it is the wrong relationship or the process has not been carried far enough. By its nature counseling forces us to confront things that are painful and that we would rather ignore. All progress proceeds through emotional pain. But if the process is not leading to breakthroughs and improvement a new provider needs to be sought.

Your description of a condition where "life conspires repeatedly to beat them down into the ground" reminds me very much of what I associate with a depressive mindset, which is to say an irrational and unhealthy one. I'm not saying that genuine adversity and misfortune are not involved. But adversity and misfortune are things you can do something about. Life "conspiring" against you is not. One of the benefits of ongoing counseling is providing an objective perspective on one's misfortunes: that is, what is a circumstance that must simply be dealt with or worked around, what is a condition that can be improved by an active response, and what things are not adversity at all but are conditions, real or imaginary, created by the depression itself.

The last issue is whether there are things that could be done to directly improve what is presumably the major underlying cause, that is, the disability caused by the accident. Are there therapeutic avenues that have not been explored? Is there any community of support, virtual or real world, around the particular disability? Are there resources for the disabled that are not being taken advantage of? Obviously having a very curtailed social and personal support network is a problem: it is a topic that has been addressed at very great length on AskMe. What are the other negative conditions in life being caused by the disability, and what can be done about them?

But it is very difficult, I think, to address and follow through these kinds of pragmatic approaches in the midst of serious depression without the support of ongoing counseling, which provides encouragement unencumbered with emotional attachment and the obligation of a loved one's expectations, objective assessment and accountability.

I hope this individual elects to keep seeking therapy and support. Battling depression is a long and slow and incomplete process, but real improvement is possible.

As a minor administrative note you might want to separate the tags disability and depression, and you might find insights in exploring other questions with those tags.
posted by nanojath at 9:55 PM on June 28, 2007 [1 favorite]


this is just my personal opinion but I think unresolved anger is likely to be a big part of the issue. Being brave and bearing up and all is great and fine but this person is young and probably extremely pissed off about being so limited. Being able to express that and work through it and finding new things to do that are challenging and produce the same level of accomplishment could potentially help a lot.
posted by fshgrl at 10:18 PM on June 28, 2007


A close friend broke his back at age 20. He got through it by deciding that God had let him live for a reason. (I imagine if you don't already think this, the suggestion will annoy you.)
posted by salvia at 10:42 PM on June 28, 2007


Response by poster: To clarify my question -

This is not regarding me, but my adult child.

It is not simply depression from a biological cause, but from a total life change - being unable to do almost **everything** that was once enjoyed.

The description I gave of the mindset is indeed a negative and unhealthy thought pattern......it is not my own, but what is described to me. Even though I am not this hopeless, I do understand. It is really almost beyond belief - the difficult events and unfair things keep continually happening to the one I write about. With each one, I have to wonder if there hasn't been enough suffering - why more? I know that life isn't conspiring, but I'm telling you that sometimes it feels that way when yet another bit of bad news comes or another ordeal.

You are right that varied painful circumstances cause many common feelings that can help others understand and support us even though their suffering is for a different reason than ours. BUT there are also many difficulties that enter into this that the average person could not understand if they haven't been through extensive rehabilitation, numerous medical appointments and treatments, etc.

To suffer the loss of one's identity is shattering: a formerly physically active person who literally cannot participate in any of those things any longer; a person who doesn't feel capable of carrying out the role of one's gender; a person who had so much promise and potential and was a hard worker, who now might never be able to work and will very possibly always be poor; a person who was a good friend and thought the friendships were reciprocated - only to be abandoned or taken advantage of by people who thought you were going to get rich; a person who was independent but now has to depend on parents for support and help with some activities of daily living; a person who was confident but who now sometimes endures humiliating symptoms; a person who used to be well-spoken and personable, but who is now wrongly thought by some to be mentally impaired.....the list goes on. The current isolation is partly by choice (because of depression & humiliating symptoms), but also partly because of reactions of others.

Some people in different circumstances could offer generalized advice, as I believe I already have, but it needs to be said by someone who has truly been there, not just someone who has had some hard times.

I realized that there was little hope of finding such a person here, but there was another emotionally traumatic incident today, with an attempt to do an activity that recently has seemed possible and aroused hope in all of us. It not only failed, but also resulted in breaking something and almost resulted injury. When I saw the resulting emotional shattering, I can't help but reach out and hope that one person might be out there who can offer some helpful advice from personal experience.
posted by onemorething at 10:55 PM on June 28, 2007


Response by poster: Me again....

sculpin, thanks for the thoughts. These are the type of things I keep saying, but since the depression is so deep and paralyzing, what I say is not being received, let alone acted upon. That is what I seek help with - how to jar a person in this condition into taking steps forward. I keep wondering if advice would be better received if it came from someone who had experienced something close to the same.

salvia -
A broken back was one of my child's injuries, and not the worst one. That thought is one that kept motivating my child through the first two years, but one setback after another has made it impossible to feel that way anymore. If there was an inkling why God had allowed this to happen, and didn't allow death to occur, I think there would be a little less hopelessness, confusion, and pain. A person without purpose is a person without hope.
posted by onemorething at 11:07 PM on June 28, 2007


onemorething- I know a woman who was a pro athlete when she suffered a head injury that has left her a near quadraplegic. A single mother, who made her living physically she was in an unfathomable position to most. She managed to salvage it all by being incredibly proactive. As soon as she got home from the rehab facility she set up shop as a full time coach, using a loan to convert her private facilities to ones suitable to teach. It's not at all easy and the hardest part was forging new relationships with her family and clients while still keeping her authority as a coach. She's made it work though and is an absolute inspiration to everyone who knows her. As well as a damn good coach. Very much the hub of a big wheel.
posted by fshgrl at 11:24 PM on June 28, 2007 [1 favorite]


Onemorething: I did not become disabled due to an injury; my disability is a combination of things that I've had all my life (or as far back as I remember) and a progression in symptoms. So although I have not gone through the grieving period in quite the same way as someone disabled late in life, I've known people who have, and I've had experiences that give me some insight as to what may be going on - among them, the endless medical treatment, lots of surgery and rehab, the stigma of disability, etc. And I'm at a similar age to your child.

I don't know the extent or manifestation of your child's disability, so I'm going to be somewhat vague here. First, it should be noted that it's not uncommon for a post-injury depression to last for four or five years as in your case; sometimes it's a lot shorter (to the point of being nonexistent), sometimes it's longer (so it's not time to give up yet and assume this is the status quo).

You seem to already know this, but I'll say it anyway: purpose is critical. Whether that's college, or work, or a non-traditional path like writing or political lobbying (just examples). Something to be passionate about is good, but it's more important is that this is something to do. Anything that gets you out of bed (perhaps figuratively) on a regular basis with something to do besides dwelling on how life seems to suck. Something that adds structure to life. Sort of a 'fake it 'till you make it' approach, that will eventually transition into 'hey, I'm doing something that makes me happy'.

You've mentioned psych meds and therapy. This is something that is worth sticking with, even if you move from therapist to therapist. It's not going to make things better on its own, obviously, but it's another source of structure (which can be very helpful in dealing with depression). It might also be helpful to find someone who understands disability, or even a mentor with a disability. In fact, finding positive role models with disabilities is a good idea - not Stephen Hawking or FDR, necessarily, but maybe people like Justin Dart, "Special" Ed Roberts, Bob Kafka, I. King Jordan, and so on. Better still if you can find role models to interact with - perhaps there's a support or social group in your area of/for people with disabilities similar to your child's. (Or any disability, really - internalizing positive ideas about disability is not something that has to be specific to a given impairment).

I'm rambling here, so I think it's time to stop, particularly since I'm being (necessarily) vague. If you want to hear more, or if I can help in any way, please don't hesitate to email me (it's in my profile - I might not be able to check it next week, though).
posted by spaceman_spiff at 12:01 AM on June 29, 2007


My father was 17 when the car in which he was riding skidded on a patch of black ice and crashed into a telephone pole. (Alcohol and/or drugs were not involved.) His spinal cord was severely damaged--nearly completely severed--and he became a paraplegic.

Before the accident, he was a senior in high school. He was captain of his baseball, basketball, and football teams. He was the class president. His girlfriend was the captain of the cheerleading squad.

After the accident, he was in the hospital for a year and a half. His girlfriend broke up with him. He obviously couldn't play high school sports any longer. Every part of his identity as a teenaged boy was gone, and he had no idea who, or what, he was.

He says over and over again that the only thing that got him through it was the support of a peer counselor named Kenny that he met in the hospital. Kenny had gone through a very similar experience and was able to help my dad put his injury in perspective--not exactly an easy thing for a teenager to do, even under the best of circumstances!

If your child doesn't yet have a peer counselor, it's never too late, and maybe it'll help your child the way it helped my dad.

Where are you located? If you're in the US, I'm sure my dad can pass along contact information about resources in your area. Please don't hesitate to contact me (my email is in my profile) if you'd like.

(Incidentally, my father's story has an absurdly happy ending. He went to college, though not on one of the many athletic scholarships he'd received before his injury. He graduated and began work with the state as an advocate for the rights of people with disabilities, at one point working directly for the governor as his Americans With Disabilities Act implementation coordinator. And as a direct result of the peer counseling he received, he became involved in wheelchair basketball. He played for 30 years, and coaches the team now. He scored 15,000 career points with his team, and won an Olympic gold medal with the US wheelchair basketball team in 1972. He met my mom after his accident thanks to the basketball team, and they had me the good old-fashioned way a couple of years after they got married. There was a great Sports Illustrated article about him a couple of years ago if you or your child are interested in hearing more [please pardon the self-link--it's the quickets access I have to the article].)
posted by jesourie at 5:56 AM on June 29, 2007 [1 favorite]


As a person who was diagnosed with an autonomic disorder just entering college, there's some I can relate to here, and some not. Most of what I would say has already been said.

I was incredibly sad, and then incredibly angry: adjusting to being a different self than you thought you'd be, after all, can create a kind of grief process. Someone in this position should probably be especially wary of that bargaining stage, where you might push yourself too hard and make things worse.

I found that regarding the anger, I had to get to a place where I accepted (don't read that as like, or approve of, please) that there were people who were never going to get it, and that it helped to channel the anger into a more political bent: what has been taken away, that needn't have been? Can you no longer get into your favorite concert hall or movie theater, say, because of a set of stairs? There's action to be taken on that front, energy that is useful there that would be wasted on trying to change any one person's mind.
posted by RobotHeart at 7:54 AM on June 29, 2007


Oh, and that said, maybe one could find places that are accessible in all senses of the word: you can actually get in, and there are like-minded people (even if not disabled). Possibly a support group? (I did not have this, and wish I had.) Possibly some other kind of activity.
posted by RobotHeart at 7:56 AM on June 29, 2007


I'm going to assume this person is completely physically incapacitated and dependent on other people. His/her caretaker needs to find a support group for the disabled. As you note, only others who have dealt with the situation can really understand. There's the added benefit that those in similar situations will not be trying to take advantage of the person. If the person can speak, he/she can use a microphone and webcam to communicate, even if he/she can't type.

I'd make the support network the #1 priority. The caretaker can also benefit from talking to other caretakers, and asking how they've dealt with the emotional impact.

This is going to seem like a non-sequitur, but a puppy or kitten could also bring joy and purpose to a severely depressed person, especially if that animal was rescued from a shelter. If that is not possible, perhaps planting flowers on his/her windowsill. Anything living and growing can foster hope.

My compassion and thoughts are with you today.
posted by desjardins at 8:02 AM on June 29, 2007


jesourie, having dealt with disabilities of my own, this quote from your article brought tears to my eyes:
Still, sitting in a wheelchair is -- on its own -- hardly heroic. And yet, says Kosloski, "people always want to place us on either end of the bell curve: We're [seen as] especially courageous and inspiring, or we're helpless objects of pity."
posted by desjardins at 8:04 AM on June 29, 2007


If your child was athletic before, you might want to look to organizations like the Quadrepeligic Rugby Association for support and guidance. There's a documentary called Murderball that follows a couple of the teams through the course of a season, and the guys talk a lot about what it took to get them out of that dark place and able to reconnect with being alive again. Many of them talk about regaining purpose through sport, and being able to have a goal again. It might be a great source of support for your child and you from people who have actually been there.
posted by MsMolly at 8:06 AM on June 29, 2007


onemorething, wow, my heart goes out to you and your child, and thanks for your explanation in response to my suggestion. My friend is travelling, but if I can get in touch with him, I'll ask how he got through the darkest parts of the recovery...
posted by salvia at 1:32 PM on June 29, 2007


I listen to psychologist Dan Gottlieb on the radio every week. From his About page:
In 1979, while preparing a surprise for his wife on their 10th anniversary, Gottlieb was in a near-fatal automobile accident, which left him paralyzed from the chest down. Over the ensuing years, he faced depression, divorce and the death of his wife, sister and parents. Throughout all, he maintained his devotion to family and his career. Now, he sits in a wheelchair observing life and gaining unusual insight into what it means to the human.
His website has links to his broadcasts, and there is contact info available. I am sure he has some insight to offer.
Good luck to you both.
posted by RussHy at 4:29 PM on June 29, 2007


Dear Onemorething, As I read your post tears flood out, I do understand this situation. I became disabled at age 29, now 18 years later . I do wish I could say I know the answer to stop the depression. I too have severe depression , alot lately, maybe because it is so close to the anniversary date. At first I coped very well, but as we age and our bodies, coping becomes more important. My husband has made a keen observation that has helped quite a bit, it is seperating the physical with the mental, kind of like looking at both peice seperately. So for me, that means making sure physically I make a check list of physical needs, and make sure they are met each day. IE 1. Have I consumed enough liquid so my body cleans out the toxins, 2. How is my nutruition ? Have I eaten enough protien and other healthy foods ( Sugar gives you a good feeling, but it is not life sustaining. 3. Am I getting at least 20 minutes of sunshine ( out side ) a day. In the winter I have purchase a plant light( Winter is harder to get the sun. ) How is my folic acid. ( Did I take a good multi supplement ) . Move as much as possiable ( even with our limitation we need to move, or be moved. ( Limit tv time, I know it seems to fill the day, but watch out for the commericals they are not very life affirming. Also watch for Life affriming program ie games. 5. Physical contact is very important, proably more important then to most. Hugs, hugs and more hugs.
Mentally I must always remind my self I am not my disability. I think this issue can not be summed up in such a short answer. Each day is its own opportunity. I know it hard when out and about, and you hear some say " She can't walk " or" look she pushes the grocery cart with her legs" or so many other insensitve remarks. For me this has taught me we all have a disability, just some of us are more obvious. I wish we all could accept each other as is, and embrace each other. Because at some point in all of our lifes we all have hard days.
Onemorething, at this moment I embrace you and your loved one with love, acceptance and grace. Thank you for being open enough to share your opportunity, for it has given me the opportunity to open my heart and embrace. Blessings. movingforwardtoo. ps sometimes some of the meds taken can cause depression (dark feelings) esp antibiotic ( I am here.)
posted by movingforwardtoo at 1:29 PM on July 10, 2007


Dear Onemorething,
After another hard night sleep due to a surgery I had, that the surgeron took a stitch in my right ureter. I am reminded where my true depression began. It began with the medical battle that I fight each day due to the careless action of a doctor. Mind you not all doctors are careless. As I think back I didn't really start to have depression until then. I had been coping with all the disablitiy items. I think when you have to fight every day to feel good, or if you are in constant infection it can really effect ones moods. So I check back in to say. All we can do is fight each day, and don't let the darkness take you down.
posted by movingforwardtoo at 9:04 AM on July 14, 2007


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